A Multidisciplinary Quality Improvement Initiative for Influenza Disease Management Lead by Internal Medicine House Staff.

Abstract

Background. Each year, influenza season has a substantial impact on our hospital census and resource utilization. Managing influenza patients continue to challenge healthcare providers. This season, our medicine residency program initiated a quality improvement (QI) initiative to optimize influenza prevention, control and treatment strategies on our medical wards. Methods. In November 2015, our influenza QI team of medical residents provided education to staff on influenza prevention, control, and treatment guidelines. A fact sheet was also distributed on modes of transmission, PCR testing, isolation, and oseltamivir dosing. Data were collected prospectively from the electronic medical record on 146 admitted Influenza A and B positive adult patients between December 2015 and March 2016. Infection control and antimicrobial stewardship services supervised the QI team. Results. Of 146 adult influenza patients, 53 had documented influenza vaccination. The remainder were unvaccinated or had unknown vaccine status. Sepsis criteria were met in 70 patients with 9 deaths observed in this group. Most common comor-bidities were hypertension, diabetes, and chronic kidney disease. Mean turnaround time of on-site influenza PCR test was 200 minutes. Time from result to first administered oseltamivir dose ranged from 10 minutes to 8 hours. Time from result to isolation ranged from 1 to 17 hours. Symptom resolution at discharge was seen in 137 patients. Oseltamivir was dosed inappropriately for creatinine clearance in only 7 patients. All patients received the recommended 5-7 day oseltamivir course, unless death occurred prior to completion. Those discharged early received a prescription for the remaining course. Conclusion. Optimization of inpatient influenza management requires a multidis-ciplinary collaboration of medical providers, infection preventionists, laboratory, and antimicrobial stewardship. Our QI project results indicate that time to isolation and initial treatment varied widely, while oseltamivir dose and duration were appropriate for most patients. Next season, we will focus on time to isolation and antiviral treatment to potentially improve patient outcomes and prevent nosocomial transmission.